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At least 1,297 records · Page 72Linked to original sources

PubMed1996

Description of new composite tissue transfer for salvage of a complex hand defect.

Leiomyosarcoma of the soft tissue involving bones is an extremely rare tumor. In the past, a hand tumor of this type required amputation. Presently, with improved chemotherapy and reconstruction, the hand and its dexterity sometimes can be saved. In this case, after chemotherapy, the authors opted for wide excision including the skin, tendons, muscles, and bones. The large defect was reconstructed with an iliac crest autograft and a dorsalis pedis free flap including tendons. Functional result was excellent in this patient. The pathologic results also were reviewed by histology, immunohistochemistry for muscle marker, and electron microscopy.

Adult↗

PubMed1999

Suspension systems for prostheses.

The appropriate suspension system results in a safe and well functioning lower extremity prosthesis. Residual limb length, joint ligament stability, and limb volume determine suspension methods as does activity level, dexterity, success of previous suspension, and cosmetic requirements. The supracondylar suspension cuff, prosthetic sleeves, and gel liners with locking mechanisms generally are indicated for the average to long transtibial amputation level. Short limbs are better fitted with supracondylar and suprapatellar suspension. Waist belts generally are indicated for patients with new amputations or those with vascular compromise. Suction suspension is the most desirable form of transfemoral suspension and is recommended for most standard to long residual limbs. Roll on silicone liners with or without locking pins and the hyperbaric sock offer the patient systems that are easier to don yet still provide unencumbered suspension. The total elastic suspension belt offers excellent auxiliary suspension and can be applied to the prosthesis by the patient. Multiple factors and patient preference should be considered when prescribing suspension systems for lower extremity prostheses.

Artificial Limbs↗

PubMed2001

Release of flexors and intrinsic muscles for finger spasticity in cerebral palsy.

Between April 1987 and March 1996, 32 deformed hands of 31 patients with cerebral palsy were treated with combined release of the flexor digitorum profundus, flexor digitorum superficialis, and intrinsic muscles. Of these 31 patients, 26 patients (27 hands) were followed up after treatment. Improvements were evaluated by the modified classification of Zancolli et al, the classification of House et al, the object handling score, and the activity of daily living score. Improvements of more than one level on an average were observed in the modified classification of Zancolli et al and the classification of House et al. The ability to grasp, pinch, and release increased with improvement of 2.5 points in the object handling score, and activities of daily living were enhanced with improvement of 2.4 points. The fine motor skills could be facilitated, and dexterity was restored in most patients.

Adolescent↗

PubMed1992

Correlates of successful hearing aid use in older adults.

OBJECTIVE: To evaluate whether age, education, functional handicap, degree of hearing loss, amount of hearing and speech recognition gain achieved with hearing aid, locus of control, visual acuity, manual dexterity, number of comorbid diseases, and number of medications predict which elderly individuals with hearing loss are likely to benefit from hearing aids. DESIGN: A logistic regression prediction model for hearing aid benefit was developed on a training set of 89 individuals and verified in a test set of 87 individuals. Hearing aid success was assessed 4 mo after hearing aid adminstration. It was defined by assessing hearing aid satisfaction, functional handicap change post-hearing aid, and number of hours of weekly hearing aid use. SETTING: All patients were elderly male veterans from the Audie L. Murphy Memorial Veterans Hospital. There were no differences in demographic or clinical characteristics in training versus test set individuals. RESULTS: Several variables, including baseline perceived functional handicap, education, number of medications, and age correlated with individual success measures. However, no variables consistently correlated with all success measures. The accuracy of prediction rules for success utilizing the variables ranged from 75 to 88% in the training set, and 54 to 84% in the test set. CONCLUSION: Although certain baseline factors were statistically significantly related to individual measures of successful hearing aid use, no factors were good enough to consistently differentiate successful from unsuccessful hearing aid candidates.

Age Factors↗

PubMed1988

A small, multi-element fingertip dosimeter for beta radiation.

Many occupations involve potential exposures, directly or indirectly, to sources of beta radiation. The region of highest exposure, in many cases, will be the extremities and in particular the fingertips of people handling beta sources. Because current extremity dosimeters can significantly underestimate beta doses to the fingertips, an improved fingertip beta dosimeter was developed. The dosimeter employs a multi-element, multi-filter concept by stacking four or five thin (0.13 mm) LiF-Teflon TLDs to form the beta detector element. The entire dosimeter is approximately 1 mm thick, flexible and rugged enough for field use without interference of the user's manual dexterity. The fingertip dosimeter provides data for determining the beta energy of each exposure. The beta energy can be used to determine the TLD correction factor for converting the TLD output to beta dose. The data can be used to reconstruct the beta depth dose curve and the depth dose curve can be used to calculate the beta dose in tissue at 7 mg cm-2, for legal reporting purposes, or at any other desired depth within the range of the beta radiation. Relationships between the effective mass absorption coefficient and beta energy and between the beta correction factor and beta energy were determined for use in this study. Beta sources were fabricated for these studies, and an extrapolation chamber was used to determine reference beta doses. Tests of the fingertip dosimeter were performed by exposing it to single beta sources and to multiple beta sources. The dosimeter should be useful for monitoring exposures to beta energies ranging from 0.29-2.5 MeV.

Beta Particles↗

PubMed1988

Estimation of tissue volume from serial tomographic sections. A statistical random marking method.

Computer operator-interactive planimetric methods that have been employed to measure volume of a selected tissue in serial computed tomographic sections are time consuming, and the accuracy of the measurement is limited by the operator's skill in outlining the tissue. We introduce an alternate method that is 5 to 6 times faster than planimetry and is independent of the operator's outlining dexterity. This method involves the random marking of voxels in a three-dimensional array of known size and subsequent identification of the proportion of those voxels that are within the tissue of interest. Tissue of the kidney and left ventricular myocardium were imaged in situ with a high speed, volume scanning, computerized x-ray tomographic imaging system. Volumetric measurements made by the random marking method correlated highly (r = 0.99) with measurements made by planimetry and with postmortem weight. These data indicate that the random marking method provides a rapid and accurate means of estimating tissue volume in serial tomographic sections.

Animals↗

PubMedDate not supplied

Functional MRI: primary motor cortex localization in patients with brain tumors.

PURPOSE: Our goal was (a) to test the ability of functional MRI (fMRI) to localize the hand primary motor cortex in patients with brain neoplasms using a conventional scanner and (b) to compare within the same subject the location and morphology of the activated motor areas in the affected hemisphere with the contralateral ones. METHOD: Seventeen right-handed patients with frontoparietal intra- and extraaxial tumors were studied. Hand motor performance ranged from normal to slight impairment of finger dexterity. The fMRI study was based on a series of FLASH images. Two or three contiguous slices parallel to the bicommissural plane were acquired through the level of frontoparietal cortex. Each patient was requested to perform with each hand a finger-tapping task or a simpler repetitive flexion-extension of the last four fingers. Pseudo-color activation maps were then calculated by a Z-score method and superimposed on high resolution images. RESULTS: Five patients were excluded because of gross motion artifacts. In all other patients, areas of significant signal increase were detected on the precentral gyrus. They had a spot-like appearance, and no substantial side-to-side differences in shape or extension could be observed. In the presence of severe compression of the gyri, a displacement of the activated areas in the affected hemisphere with respect to the contralateral ones was noticeable. CONCLUSION: fMRI localization of the primary motor area using a conventional scanner can be obtained also in patients with brain tumors, although with a lower success rate than in normal volunteer studies, mainly because of subject compliance problems. Areas of significantly increased signal are detectable even in cortex where normal anatomical patterns are lost.

Adolescent↗

PubMed2002

Effects of six anti-hypertensive medications on cognitive performance.

OBJECTIVE: To describe and compare the effects of six different antihypertensive medications on cognitive performance. DESIGN: Prospective, randomized, and double-blind with treatment cross-over. SETTING: University hypertension clinic and neuropsychology laboratory. PARTICIPANTS: Ninety-eight Caucasian men between 25 and 55 years of age with mild-to-moderate essential hypertension (88 of whom completed the study), and 32 normotensive men with similar socio-demographic characteristics. INTERVENTIONS: Six-week treatment periods with atenolol, metoprolol, hydrochlorothiazide, methyldopa, enalapril and verapamil, and 2-week placebo baseline and wash-out periods. MAIN OUTCOME MEASURES: In-depth neuropsychological assessments and several mood questionnaires were completed during placebo (baseline) periods and active treatment periods. Practice effects due to repeated neuropsychological testing were estimated from data collected concurrently in the normotensive participants. RESULTS: The antihypertensive treatments lowered blood pressure comparably and did not affect mood or anxiety. Small treatment effects were noted in four of seven domains of cognitive performance. Irrespective of medication type, treatment reduced the simple motor speed (P < 0.001), and slowed completion of two tests measuring perceptuo-motor speed and mental flexibility (P </= 0.05). Manual dexterity declined somewhat with metoprolol and methyldopa (P = 0.01). In contrast, all antihypertensive agents favorably affected performance on several tests that require working memory (P < 0.01). Performance on other tests assessing grip strength, learning and memory, attention and executive function was not affected. CONCLUSION: Short-term treatment with standard antihypertensive medications was associated with some small decrements in psychomotor performance and small improvements in working memory, without notable drug-class differences. Long-term effects await further study.

Adult↗

PubMed2004

A laryngeal dissection station: educational paradigms in phonosurgery.

OBJECTIVES: To introduce a new tool for phonosurgical training and education. A multitude of innovations in complex laryngeal surgery has catalyzed new educational initiatives. Establishing dexterity in phonomicrosurgery is often difficult to achieve while working on patients because of the narrow margin for success. Furthermore, laryngoplastic phonosurgery and open partial laryngectomy require sophisticated knowledge of precise anatomic relationships, which can be difficult to express in images. Finally, many teaching programs do not have a high volume of these procedures, and there is a significant need to transmit this information in continuing education courses. STUDY DESIGN: Prototype design. METHODS: A laryngeal dissection station (LDS) was designed to facilitate the acquisition of high-level procedural skill sets for both transoral and transcervical techniques. RESULTS: This LDS can be used in existing temporal-bone laboratories by using cadaveric larynges. A rectangular frame supports two adjustable holders, one for the larynx and one for the examining speculum of a laryngoscope. Procedures are performed with the larynx fixed in space by a novel fixator. Variation in position and orientation of the components affords simulation of both microlaryngoscopy and open surgery. The dissection station can accommodate virtually any laryngoscope, regardless of size or shape. CONCLUSIONS: This training apparatus should facilitate laryngeal surgical instruction in residency training and continuing medical education. This device and others like it can help establish clinical competency in laryngology, should this become necessary in future educational models of residency training and recertification.

General Surgery↗

PubMed2000

Health Utilities Index Mark 3: evidence of construct validity for stroke and arthritis in a population health survey.

BACKGROUND: The Health Utilities Index Mark 3 (HUI3) is a comprehensive, compact health status classification and health state preference system. The HUI3 system has been included in 4 Canadian population health surveys and numerous clinical trials. OBJECTIVES: To evaluate the construct validity of the HUI3 for the measurement of health-related quality of life (HRQL) and attribute-specific morbidity in respondents to the 1990 Ontario Health Survey reported to have arthritis or stroke. The authors assessed (1) whether those with stroke, arthritis, and both conditions had lower HRQL scores than those with neither condition and (2) whether HUI3 detects morbidity in specific health attributes affected by arthritis and stroke. Stroke (but not arthritis) were expected to affect speech and cognition; arthritis (but not stroke) to affect pain; both to affect mobility, dexterity, and emotion; and neither to affect vision and hearing. RESEARCH DESIGN: Linear regression models of HRQL and attribute-specific utilities were estimated as a function of 3 indicator variables of health problem (stroke only, arthritis only, both) and variables included to reduce confounding. RESULTS: Subjects with stroke, arthritis, and both conditions had substantially lower HRQL than those with neither condition. Stroke subjects had greater morbidity in speech and cognition than arthritis subjects; somewhat surprisingly, pain morbidity was only slightly higher among arthritis subjects; neither condition affected vision or hearing. These associations were robust to various model specifications. CONCLUSIONS: The HUI3 system appears valid for measuring health status and HRQL for stroke and arthritis in the context of a noninstitutionalized population health survey.

Activities of Daily Living↗

PubMed2002

Multiattribute and single-attribute utility functions for the health utilities index mark 3 system.

BACKGROUND: The Health Utilities Index Mark 3 (HUI3) is a generic multiattribute preference-based measure of health status and health-related quality of life that is widely used as an outcome measure in clinical studies, in population health surveys, in the estimation of quality-adjusted life years, and in economic evaluations. HUI3 consists of eight attributes (or dimensions) of health status: vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain with 5 or 6 levels per attribute, varying from highly impaired to normal. OBJECTIVES: The objectives are to present a multiattribute utility function and eight single-attribute utility functions for the HUI3 system based on community preferences. STUDY DESIGN: Two preference surveys were conducted. One, the modeling survey, collected preference scores for the estimation of the utility functions. The other, the direct survey, provided independent scores to assess the predictive validity of the utility functions. MEASURES: Preference measures included value scores obtained on the Feeling Thermometer and standard gamble utility scores obtained using the Chance Board. RESPONDENTS: A random sample of the general population (> or =16 years of age) in Hamilton, Ontario, Canada. RESULTS: Estimates were obtained for eight single-attribute utility functions and an overall multiattribute utility function. The intraclass correlation coefficient between directly measured utility scores and scores generated by the multiattribute function for 73 health states was 0.88. CONCLUSIONS: The HUI3 scoring function has strong theoretical and empirical foundations. It performs well in predicting directly measured scores. The HUI3 system provides a practical way to obtain utility scores based on community preferences.

Adolescent↗

PubMed1998

Stereoscopic head-mounted display incorporated into microsurgical procedures: technical note.

OBJECTIVE: We have previously evaluated video technologies that have allowed for the use of electronic imaging during microneurosurgical and endoscopic procedures. This stereoscopic camera set and monitor/recording system allows for the use of stereoscopic images during surgery by the primary surgical assistant and ancillary personnel. It also allows for stereoscopic recording and playback using a wide video home system format. We describe a novel prototype of a head-mounted display (HMD) that allows the surgical team to simultaneously visualize the surgical field stereoscopically and includes picture-in-picture, voice control, and stereoscopic recording capabilities. INSTRUMENTATION: A stereoscopic HMD with 640 x 480 (video graphics array) pixel resolution and the ability to display 24-bit images has been designed. This device weighs 900 g. It is interfaceable with common video display formats. RESULTS: This stereoscopic HMD is being evaluated in a prospective multicenter trial of open microsurgical and endoscopic minimally invasive procedures. In our experience to date, there have been no equipment failures or complications attributable to the use of the display system. The equipment was well accepted by users who reported significant benefits in visualization. CONCLUSION: The use of a stereoscopic HMD may result in improved efficiency and safety in both endoscopic and open microsurgical procedures. We have verified that the HMD is comfortable during the course of a surgical procedure, is reliable, and allows for accessibility to the operative field with an excellent field of view and three-dimensional perception. Positioning and dexterity within the operative field are also enhanced. Additional uses relate to surgical training, multimodal information display, and operative rehearsals.

Depth Perception↗

PubMed1999

M. Gazi Yaşargil: the time in Little Rock.

Microneurosurgery is Professor Yaşargil's legacy. Its impact on patient outcomes, surgeons' abilities, the field of neurosurgery in particular, and the art of surgery in general is great, profound, and everlasting. Professor Yaşargil led a revolution that has transformed neurosurgery into the fine art we practice today. His ingenuity, devotion, energy, and masterful technique have made his contributions so salient that they have earned him recognition as Neurosurgery's Man of the Century. It has been an honor, a great opportunity, and a phenomenal experience to spend the last 5 years with him at the University of Arkansas for Medical Sciences in Little Rock. There, he represents the very best in knowledge, expertise, dexterity, and, above all, devotion to advancing the field of neurosurgery. Most enjoyable have been his stimulating intellect and inspiring vision.

Arkansas↗

PubMed2001

Robot-assisted microsurgery: a feasibility study in the rat.

OBJECTIVE: Telerobotic surgery is a novel technology that can improve a surgeon's manual dexterity as well as the results achieved with microsurgical procedures. METHODS: A prototype Robot-Assisted MicroSurgery (RAMS) microdexterity enhancement system developed by the Jet Propulsion Laboratory and MicroDexterity Systems, Inc., was tested in 10 rats. Carotid arteriotomies were created and closed using either the RAMS system or conventional microsurgical techniques. The time required, the technical quality (vessel patency and suture line integrity), the error rate, and subjective difficulty were compared. RESULTS: All procedures were successfully completed using the RAMS system to manipulate the vessel but not to hold the needle or place the sutures. The precision, technical quality, and error rate of telerobotic surgery were similar to those of conventional techniques. However, the use of the RAMS system was associated with a twofold increase in the length of the procedure. CONCLUSION: Surgery using a microdexterity enhancement system, or RAMS prototype, is feasible. With further development, such as a stereotelevisualization and haptic feedback system, this system could be used for telerobotic surgery in neurosurgical practice.

Animals↗

PubMed2002

A quantitative analysis of sutural contributions to variability in back vertex distance and transmittance in rabbit lenses as a function of development, growth, and age.

PURPOSE: To correlate specific parameters of lens structure (anterior and posterior suture branch length and planar area) with variability in back vertex distance (BVD) and scatter in rabbit lenses as a function of development, growth, and age. METHODS: Lenses from juvenile (n = 9), adult (n = 9), and aged (n = 10) New Zealand White rabbits were utilized in this study. After sacrifice, lens suture patterns were photographed using a stereo surgical dissecting microscope. Within 5 min of sacrifice, average BVD, variability in BVD, and scatter were assessed with a Scantox In Vitro Assay System. Laser beams were passed incrementally along anterior and posterior suture planes through right eye (oculus dexter, OD) lenses, and between suture planes through left eye (oculus sinister, OS) lenses. After fixation, lens axial dimensions and suture branch lengths were assessed and used to create scaled, 3-dimensional computer assisted drawings (3-D CADs) depicting gross lens shape and sutural changes throughout life. RESULTS: Whereas average BVD only increased significantly as a function of growth, variability in BVD only increased significantly as a function of aging. However, anterior sutures exerted a greater influence on variability of BVD than posterior sutures throughout growth and aging. This difference is consistent with anterior suture branches being longer, or extending farther peripherally, than posterior sutures. Scatter was essentially unchanged between juvenile and adult lenses but significantly increased in aged lenses. Notably, posterior sutures effected a greater age-related increase in scatter than anterior sutures. This difference was consistent with the formation of numerous small, posterior subbranches and subplanes later in life. Structural analysis also suggested that asymmetric age-related lens compaction had occurred, predominantly affecting posterior lens dimensions. CONCLUSIONS: Lens sutures significantly influence average BVD throughout development and growth, and variability in BVD throughout aging. In addition, even though the rabbit lenses appeared transparent throughout growth and aging, unequal length and area of anterior vs. posterior suture branches and planes respectively, as well as a greater degree of age-related posterior lens compaction, were factors contributing to increased scatter.

Aging↗

PubMed2001

Endoscopically assisted, intraorally approached corrective rhinoplasty.

In the field of facial surgery, operations that require guesswork can result in unexpected complications. One example of such "blind" facial surgery is the lateral osteotomy procedure in corrective rhinoplasty. In most conventional corrective rhinoplasties, the postoperative results of a lateral osteotomy can be controlled by the surgeon's visual perception or manual dexterity; therefore, an experienced surgeon is indispensable in such elaborate operations. Until now, reports have focused on the endoscopic approach through the nasal dorsum or septum through the nostril. However, because of the difficulty in handling the endoscope with osteotomy instruments, it is considered difficult to perform a precise lateral osteotomy procedure using that approach. The authors think the intraoral endoscopic approach should be considered a viable alternative in corrective rhinoplasty. Through small, bilateral gingivobuccal incisions, both the piriform apertures and nasal bones can be easily exposed, and the exact level of the lateral osteotomy can be confirmed directly under the endoscope. The lateral osteotomy is made simply with a reciprocating saw, and symmetrical cutting can be ascertained during the operation. Sometimes, a particular osteotomy level or the proper repositioning of osteotomed segments can be readily evaluated with assistance from the endoscope during the operation. Eleven cases using this procedure were performed over the past 3 years. These endoscopic repairs for a deviated nose were quite helpful for visual confirmation and accurate correction. No complications occurred when using the endoscope with this procedure.

Adult↗

PubMed1991

Hand function in patients with diabetes mellitus.

Using validated clinical tests and standardized controls, we measured hand function in diabetic subjects. Fifteen diabetic patients (median age 48 years), all having used insulin for a minimum of 5 years, were randomly selected from inpatient and outpatient services of an academic medical center. Testing was done on an outpatient basis. The three hand function tests used were the Purdue Pegboard, O'Connor Tweezer Dexterity, and Smith Hand Function. A symptom questionnaire was also included in the study. Function was significantly decreased in the diabetic group, and the decrease was out of proportion to their own subjective pretest assessments. These findings may have implications for occupational performance as well as activities of daily living.

Activities of Daily Living↗

PubMed1996

Persistent neurotoxicity from a battery fire: is cadmium the culprit?

Two train conductors had chest tightness, painful breathing, muscle cramps, and nausea after fighting a fire in a battery box under a passenger coach. Shortly thereafter, they became anosmic and had excessive fatigue, persistent headaches, sleep disturbances, irritability, unstable moods, and hypertension. Urinary cadmium and nickel levels were elevated. Neurobehavioral testing showed, in comparison to referents, prolonged reaction times, abnormal balance, prolonged blink reflex latency, severely constricted visual fields, and decreased vibration sense. Test scores showed that immediate verbal and visual recall were normal but delayed recall was reduced. Scores on overlearned information were normal. Tests measuring dexterity, coordination, decision making, and peripheral sensation and discrimination revealed abnormalities. Repeat testing 6 and 12 months after exposure showed persistent abnormalities. Cadmium and vinyl chloride are the most plausible causes of the neurotoxicity, but fumes from the fire may have contained other neurotoxic chemicals.

Accidents, Occupational↗